January 22, 2013
Supreme Court Action: Time Limits in Administrative Appeals
The Supreme Court issued one opinion this morning concerning the time limit in which a medical care facility can request a review of its reimbursement amount for Supplemental Security Income (SSI) benefits provided under Medicare. The case is Sebelius v. Auburn Regional Medical Center ((11-1231).
Statute provides a 180 day window and Health and Human Services regulations give the Secretary the power to extend the deadline to three years. HHS uses contractors to calculate the reimbursement. One of these contractors, CMS, used flawed data to calculate SSI payments to Bay State Medical Center. Bay State timely appealed to the Provider Reimbursement Review Board (PRRB) and ultimately prevailed. In the process, the flaws were exposed, triggering appeals by other providers working with CMS. The appeals, however, were for payments that were ten years old. The District Court dismissed the other providers’ claims. The D.C. Court of Appeals reversed holding that equitable principles allowed tolling the limitations period to the administrative claims.
The Supreme Court had three choices:
Three positions have been briefed and argued regarding the time for providers’ appeals to the PRRB. First, a Court-appointed amicus curiae has urged that the 180-day limitation is “jurisdictional,” and therefore cannot be enlarged at all by agency or court. Second, the Government maintains that the Secretary has the prerogative to set an outer limit of three years for appeals to the Board. And third, the hospitals argue that the doctrine of equitable tolling applies, stopping the 180-day clock during the time the Secretary concealed the information that made the fiscal intermediary’s reimbursement determinations incorrect.
The Court rejected the first option stating that rules of statutory construction do not make the statutory time limit jurisdictional. This conclusion was based on Court precedent holding filing deadlines are not jurisdictional. If jurisdictional, the Secretary could not extend the time limit and there would be no allowance for equitable tolling. The Court of Appeals justified its reversal on Court precedent that allowed equitable tolling for suits against the United States. The Supreme Court rejected this position saying that it never applied equitable tolling rules to administrative proceedings.
The Court accepted the Government’s argument that the three year extension was a valid exercise of the Secretary’s rulemaking powers and under the Chevron case was entitled to deference. The Court of Appeals was reversed and remanded. Justice Ginsburg delivered the opinion for a unanimous Court. Justice Sotomayor filed a concurring opinion. She agreed that the result in this case is correct but would not foreclose applying equitable tolling principles from appropriate administrative cases.
Speaking of Justice Sotomayor, she appeared on the Daily Show with Jon Stewart last night:
|The Daily Show with Jon Stewart||Mon - Thurs 11p / 10c|
CMS isn't a contractor. It's the Center for Medicare and Medicaid Services, and as its name indicates, it's the branch of HHS that handles administration/reimbursement claims for those programs.
Posted by: Jim Gernert | Jan 23, 2013 9:04:51 AM